Chattogram Maa-O-Shishu Hospital Medical College Journal Volume 19, Issue 1, January 2020 Original Article Pattern of Dermatosis Among the Admitted Neonates in A Tertiary Care Hospital Shamsun Nahar1* Abstract Dipika Dey2 Background: Neonatal dermatosis are common in neonatal period of first twenty Ashek Elahi3 eight days. Most of which are physiological, transient and require no therapy, as Nasim Haider3 well as pathological lesions in the skin of neonates. This study was done to see the Rajat Sankar Roy Biswas4 pattern of dermatosis in neonates and to establish the correlation between various neonatal factors, maternal factors and the occurance of dermatosis and to identify them correctly to avoid concerns of parents, Gynaecologist and Pediatricians. 1 Department of Dermatology Materials and methods: A total of 1000 admitted neonates in a 4 month period in Chattogram Maa-Shishu General Hospital Chattogram, Bangladesh. neonatal ward of a tertiary care hospital were included in this study and a detailed history and dermatological examination including hair , nail and mucous membrane 2Department of Pediatrics of each neonate was carried out. Laboratory procedures were performed as Chattogram Maa-O-Shishu Hospital Medical College required. Chattogram, Bangladesh. Results: We found 300 (30%) newborns had one or more skin lesions out of 1000 3 Department of Dermatology newborns examined. Male to female ratio was 1.14:1. Most common skin changes Cox’s-Bazar Medical College Cox’s-Bazar, Bangladesh. observed was physiological scaling (50%), Acne neonatorum (13%), Erythema toxicum neonatorum (11%), Xerosis (10%), Milia (9%), Cutis marmorata (7%), 4Department of Medicine Infantile seborrhoic dermatitis (7%). Among congenital skin lesions, congenital Chattogram Maa-O-Shishu Hospital Medical College melanocytic nevus (1%) portwine stain (1%). Genodermatosis are Epidermolysis Chattogram, Bangladesh. bullosa (0.3%), Congenital icthyosiform erythroderma (0.3%). Acquired skin manifestation seen in 17% of cases. Conclusions: Neonates are prone to suffer from a different varieties of dermatosis both physiological and pathological which are unique to neonates. It is important to differentiate them from other serious skin conditions which shows the importance of a dermatologist in the neonatal unit of a hospital. Key words: Neonate; Dermatosis; Transient; Acquired; Congenital. INTRODUCTION Skin conditions encountered in newborns that tend to resolve by 30 days of age are considered to be transient1. They are very common and many are expected in newborns. Transient neonatal disorders characterized by a variety of clinical features and a benign course2. A thorough knowledge of these condition is mandatory in *Correspondence to: order to properly differentiate between benign disorders and other important Dr. Shamsun Nahar 3 Department of Dermatology conditions such as infections or autoimmune disorders or genodermatosis . Chattogram Maa-Shishu General Hospital Skin of neonate plays an important role in transition from an aqueous to an air- Chattogram, Bangladesh. dominant environment by providing mechanical protection, assisting thermo Mobile : +88 01711 44 84 49 regulation, immune-surveillance and fluid balance4.The skin of the infant differs Email: [email protected] from that of an adult by being thinner, delicate, weaker intercellular attachments and Date of Submission : 05.09.2019 fewer sweat and sebaceous gland secretions, weaker temperature regulation. So Date of Acceptance : 10.10.2019 neonatal skin is more susceptible to severe infections5. Majority of physiological neonatal dermatosis disappear without any treatment while www.banglajol.info/index.php/CMOSHMCJ only few are pathological6. 15 Shamsun Nahar et al Cutis murmorata talangectasia 21 7% Neonatal dermatosis are classified as follows: Cradle cap 20 6% G Transient skin disorders Vernix caseosa 15 5% G Congenital disorders- birthmarks (Nevus) Genodermatosis Icthyosis 12 4% G Acquired skin disorders specific to the neonatal period Transient pustular melanosis 7 2% 7 G Iatrogenic dermatological complications . Neonatal cephalic pustulosis 7 2.33% Skin changes are affected by hereditary,race,gestational age and Mongolian spot 9 3% maternal health in addition to other external factors such as Acquired skin disease hygiene, socioeconomic status, customs, mode of delivery etc8. Candidiasis 8 2.66% Neonatal dermatosis are a very common cause of parental Diaper dermatitis 6 2% anxiety and concern pressing the need for appropriate diagnosis Neonatal varicella syndrome 1 0.9% and counseling of parents.This avoids unnecessary diagnostic Neonatal purpurafulminants 1 0.9% and therapeutic interventions9. A number of studies have been Iatrogenic reported on neonatal dermatosis but none from this region of Bruise 2 1.8% Bangladesh. So, our study is to assess the incidence and profile Erosion 2 1.8% of neonatal dermatoses and its association with various Congenital disorder and genodermatosis perinatal risk factors in a neonatal ward of a Tertiary Care Congenital melanocytic nevus 3 1% Teaching Hospital of Chattogram. Epidermolysis bullosa 1 0.9% Congenital MATERIALS AND METHODS Icthyosiform erythroderma 1 0.9% A cross-sectional descriptive study was carried out in a Tertiary Haemangiomas 9 3% Care Teaching Hospital of Chattogram. All admitted neonates Infectious disease <28 days of life in neonatal ward between august 2017 to Herpes simplex 1 0.9% November 2017 with or without skin lesion were included in SSSS 1 0.9% the study and neonate >28 days of life, neonates with gross Bacterial conjunctivities 1 0.9% congenital malformations and critically sick neonate on ventilator were excluded. A total of 1000 admitted neonates in a Out of 300 neonates with skin lesions, 45% (135) were female four month period in neonatal ward of a tertiary care hospital and 55% (165) were male. Male: Female ratio was 1.14:1. 162(54%) neonates delivered vaginally and 138(46%) were de- were examined. A detailed history, general, systemic and livered by caesarean section. 252(84%) were delivered in hospi- dermatological examination including hair, nail and mucous tal and 48(16%) were delivered in home. Among the 300 neo- membrane of each neonate was carried out. Birth history and nates, 12(4%) were preterm, 279(93%) were term, 9(3%) were relevant maternal history including age parity, mode of delivery, post-dated. history of consanguinity and any illness during pregnancy, any About birth weight of neonates 21(7%) neonate had a birth maternal history of dermatological diseases were recorded in a weight of less than 2kg, 99(33%) weighted 2-2.5kg, 27(9%) proforma. Adequate light, proper hand washing and weighted 2.6-2.9kg, 113(37%) weighted 3kg and 40(13%) sterilization procedure were done before examination of weighted 3.5kg. Among the mothers of neonates-mothers of neonate. Photographic records were maintained with consent 30(10%) neonates were less than 20years old, 105(35%) were from parents. Simple laboratory procedures were performed as 20-24 years old, 130(43%) were 25-30 years old and 35(11%) required, like skin scraping or gram staining. Data was analyzed were older than 30 years. About parity of mothers-114(38%) and inferences were drawn using tables and statistical analysis were primigravida, 186(62%) were multipara. was done by chi- square test and t-test (One sample). Table II : Relationship of skin lesion with neonatal factors RESULTS Neonatal factors Number (%) p-value A total of 300(30%) newborns had one or more skin lesions Sex out of 1000 newborns examined. The profile and frequency of Male 165 55% 0.000 skin lesions has been detailed in table I . Female 135 45% Maturity Table I : Showing incidence of the common dermatosis in the Preterm 12 4% present study Term 279 93% 0.000 Neonatal Dermatosis Number Percentage Post dated 9 3% Birth weight Physiological scaling 50 16% <2 Kg 21 7% Acne neonatorum 38 12.66% 2-2.5 Kg 99 33% 0.000 Erythema toxicum neonatorum 35 11% 2.6-2.9 Kg 27 9% Milia 26 8.66% 3 Kg 113 37% Miliaria 24 8% 3.5 Kg 40 13% Volume 19, Issue 1, January 2020 16 Pattern of Dermatosis Among the Admitted Neonates Table III : Relationship of skin lesions with maternal factors Maternal factors number (%) p-value Parity Primigravida 114 38% 0.000 Multipara 186 62% Maternal age <20yrs 30 10% 0.000 20-24yrs 105 35% 25-30yrs 130 43% >30yrs 35 11% Mode of delivery NVD 162 54% 0.000 Figure 4 : Lanugo hair LSCS 138 46% Figure 5 : Dysquamation Figure 1: Harlequin Icthyosis Figure 6 : Acne neonatorum Figure 2 : Epidermolysis bullosa Figure 7 : Erythema toxicum neonatorum Figure 3 : Milia Volume 19, Issue 1, January 2020 17 Shamsun Nahar et al Miliaria is a group of transient eccrine disorders due to occlusion of sweat ducts at various levels, resulting in leakage of sweat in the epidermis or papillary dermis17. Miliaria in our study seen in 24(8%) neonates similar to the study of AgarwaI et al in North India that showed Miliaria in 40% neonates16. Vernix caseosa is a protective biofilm forms a mechanical 'sheild' against maceration by amniotic fluid and bacterial infection composed of water, protein and lipid18,19. It was seen in12(4%) neonates. It was seen most commonly on 1st day of life. Figure 8 : Physiological scaling Transient neonatal pustulosis is a self limited,benign dermatosis of the neonates and occurs in approximately 0.2%-4% of all DISCUSSION term neonates.The eruption is always present at birth. Lesions The spectrum of neonatal dermatosis and their differentiation are pigmented macules coexist with flaccid vesiculopustules from the more significant cutaneous disorders of the neonates is with no surrounding erythema located on the chin, neck, nape, critical. upper chest, lower back and buttock20. We found 6 cases of this Transient skin lesions in some neonates were overlapped with dermatosis in our study. other infectious diseases. By careful examinations and expert dermatological opinion will help to distinguish. Cradle cap or milk crust means common congenital scaling In our observation most common dermatosis were transient observed on the vertex,generally believe to represent persisting skin lesions.